Vertically unstable type III odontoid fractures: Case report

OBJECTIVE AND IMPORTANCE: Type III odontoid fractures are generally thought of as unstable fractures that can be successfully treated with an external orthosis. However, there is a rare subtype of Type III odontoid fractures that is similar in the degree of instability to atlanto-occipital dislocation injuries. Not recognizing or not treating this injury urgently and aggressively could lead to devastating iatrogenic neurological injuries such as quadriplegia and fatal lower brainstem palsies. CLINICAL PRESENTATION: We present the case of a 73-year-old woman with a vertically distracted Type III odontoid fracture and associated quadriparesis and brainstem deficits. The patient was kept in a rigid collar, placed in a kinematic bed, and admitted to the trauma service for the management of her life-threatening systemic injuries. Traction was not applied. INTERVENTION: As soon as the patient was systemically stable, she was taken to the operating room for C1-C2 fixation with a screw-rod construct supplemented by cable and structural iliac crest bone graft. CONCLUSION: Delayed recognition of this subtype of Type III odontoid fracture could have fatal or highly morbid consequences, such as quadriparesis/-plegia, lower brainstem dysfunction, and ventilator-dependence, for the patient. It is important to keep a high level of suspicion for this unusual subtype of Type III odontoid fracture.